Bridgette Marshall

The applicant and the respondent insurer, Aviva, both requested reconsideration of a Licence Appeal Tribunal decision regarding statutory accident benefits.

The applicant alleged procedural fairness breaches and errors of law regarding the denial of attendant care benefits and the reliance on an untested expert report.

The Tribunal dismissed the applicant's request, finding no procedural unfairness as the applicant had not properly summonsed the expert, and no error in the adjudicator's requirement for detailed invoices to prove expenses were incurred.

Aviva's request for reconsideration was granted in part to correct a mathematical error in the calculation of a bad faith award, reducing the quantum to $7,263.45.

The applicant's request for costs was denied.

The applicant, who sustained a catastrophic impairment in a 2017 motor vehicle accident, sought attendant care benefits (ACBs) and various medical and rehabilitation benefits.

The Tribunal found the applicant entitled to ACBs for specific periods based on his psychological impairments, but held the benefits were not payable because the applicant failed to prove they were incurred.

The Tribunal partially approved treatment plans for social work, aquatherapy, concussion treatment, and a home renovation assessment, while denying others that were reasonably available through OHIP.

The Tribunal ordered Aviva to pay a special award of $9,041.12 under s. 10 of Regulation 664, finding that the insurer acted unreasonably and in bad faith by pre-emptively denying treatment plans and failing to comply with procedural timelines.